A Pediatric Teletrauma Program Pilot Project: Improves Access to Pediatric Trauma Care and Timely Assessment of Pediatric Traumas

R Scott Eldredge; Zachary Moore; Julia Smith; Kasey Barnes; Sidney P Norton; Kezlyn Larsen; Benjamin E Padilla; Robert A Swendiman; Stephen J Fenton; Katie W Russell

doi:10.1097/TA.0000000000004241

A Pediatric Teletrauma Program Pilot Project: Improves Access to Pediatric Trauma Care and Timely Assessment of Pediatric Traumas

J Trauma Acute Care Surg. 2024 Apr 4. doi: 10.1097/TA.0000000000004241. Online ahead of print.

Authors

R Scott Eldredge, Zachary Moore¹, Julia Smith¹, Kasey Barnes², Sidney P Norton², Kezlyn Larsen³, Benjamin E Padilla⁴, Robert A Swendiman³, Stephen J Fenton³, Katie W Russell³

Affiliations

¹ University of Utah, School of Medicine.
² Intermountain Healthcare, Department of Surgery, Division of Pediatric Surgery.
³ University of Utah, Department of Surgery, Division of Pediatric Surgery.
⁴ Phoenix Children's, Department of Surgery, Phoenix Arizona.

PMID: 38197703
DOI: 10.1097/TA.0000000000004241

Abstract

Background: Geographic location is a barrier to providing specialized care to pediatric traumas. In 2019, we instituted a pediatric teletrauma program in collaboration with the Statewide Pediatric Trauma Network at our level 1 pediatric trauma center (PTC). Triage guidelines were provided to partnering hospitals (PH) to aid in evaluation of pediatric traumas. Our pediatric trauma team was available for phone/video trauma consultation to provide recommendations on disposition and management. We hypothesized that this program would improve access and timely assessment of pediatric traumas while limiting patient transfers to our PTC.

Methods: A retrospective cohort study was conducted at the PTC between January 2019 to May 2023. All pediatric trauma patients age < 18 years who had teletrauma consults (TC) were included. We also evaluated all avoidable transfers without TC defined as admission for less than 36 hours without an intervention or imaging as a comparison group.

Results: A total of 151 TCs were identified: 62% male and median age of 8 years [IQR:4-12]. TC increased from 12 in 2019 to 100 in 2022-2023 and the number of partnering hospitals increased from 2 to 32. PH were 15-554 miles from the pediatric trauma center, with a median distance of 34 miles [IQR:28-119]. Following consultation, we recommended discharge 34%, admission 29%, or transfer to PTC 35%. Of those that were not transferred, 3% (3/97) required subsequent treatment at the PTC. Non-transferred TC had a higher percentage of TBI (61% vs 31%;p < 0.001) and were from farther, (40 miles[IQR:28-150] vs 30 miles[IQR:28-50];p < 0.001) compared to avoidable transferred patients without a TC.

Conclusions: TC is a safe and viable addition to a pediatric trauma program faced with providing care to a large geographical catchment area. The pediatric teletrauma program provided management recommendations to 32 partnering hospitals and avoided transfer in approximately 63% of cases.

Level of evidence: IV Treatment study.